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Florida Blue / requesting peer to peer review of a claim.

3 Jacksonville, FL, United States Review updated:
Contact information:

My doctor and I have been trying for months to set up a peer to peer review of a denied claim and florida blue has made it impossible. I have made multiple phone calls, sent messages through the florida blue website, and had several chat sessions. They have not responded to any of the messages, none. The phone and chat responses are to have the doctor call the provider line. He has tried twice but it does not allow him to request the peer to peer. The automated system asks for date of service, and when he enters it, the systems responds that there is no claim for that date of service (actually there are 6) but it will not let him proceed, nor is there a way for him to speak with a person. My doctor says the claim was for a legitimate medical service and that if he could speak with a peer, he is sure they would agree. All we are trying to do is set up a peer to peer reviews, but the system will not allow it.
If the results of the peer to peer were not in my favor, then I could accept that. But florida blue not following there own policy and their customer service representatives being unable or unwilling to help find a way to set up the peer to peer is very poor. All we are asking for is a phone call for a peer to peer review and all we get is a dead end and the runaround.

Ke
May 8, 2017
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Comments

  • Jo
      22nd of Sep, 2018
    0 Votes

    Good for you, keep the pressure up, & make sure your facts are correct and true, it's the only way to get Florida Blue to change and accept their mistakes. They did it with me when they sent me a bill from a Doctor that Florida Blue paid nothing, Zero was paid, the Doctor expected me to pay the balance, but the Doctor or Florida Blue didn't know that there is a law signed into effect in April of 2016 which does not allow balance billing. I had to do my own research and in fact it's in their own policy which they missed.
    It seems with Florida Blue a patient must do their own research, because the people you talk to on the phone do not have the correct knowledge or information, it's easier for them to say no to a patient, so don't take no for an answer if you feel you are correct, because most times you will be.

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